Nurse Practitioners and Physician Assistants: An Underestimated Workforce for Older Adults with Cancer
Nurse Practitioners and Physician Assistants: An Underestimated Workforce for Older Adults with Cancer
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DOI：
10.1111/jgs.15931
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发表时间：
2019-07-01
影响因子：
6.3
通讯作者：
Stephens, Caroline
中科院分区：
文献类型：
--
作者：
Coombs, Lorinda A.;Max, Wendy;Stephens, Caroline
描述美国65岁以上癌症成人提供者劳动力的组成，并确定接受不同提供者（例如，执业护士[NP]、医师助理[PA]和专科医生）护理的患者是否存在差异。设计观察性横断面研究。在2013年监测，流行病学和最终结果癌症登记处与医疗保险索赔数据库相关联。参与者：因任何实体或血液恶性肿瘤接受门诊治疗的医疗保险受益人。国际疾病分类，第九次修订版（ICD-9），诊断代码被用来确定医疗保险的老年人恶性肿瘤患者索赔。这些门诊索赔的提供者使用与其国家提供者标识符编号相关的分类代码进行识别。结果：201237名患者的恶性肿瘤索赔共计250万件，15227名供应商与索赔相关。NP构成最大的组（31.5%; n = 4，806），其次是血液学/肿瘤学医生（27.7%; n = 4，222）、PA（24.7%; n = 3767）、内科肿瘤学家（10.9%; n = 661）、妇科肿瘤学家（2.6%; n = 403）和血液学家（2.4%; n = 368）。与医生相比，农村癌症患者更可能接受NP（比值比[OR] = 1.84; 95%置信区间[CI] = 1.65-2.05）或PA（OR = 1.57; 95% CI = 1.40-1.77）的治疗。南方患者更可能接受NP的护理（OR = 1.36; 95%CI = 1.24-1.49）。大部分老年癌症患者接受NP和PA的护理，特别是那些居住在农村和美国南部的老年人。劳动力战略需要整合这些提供者群体，以有效应对老年人对癌症护理日益增长的需求。
OBJECTIVES To describe the composition of the US provider workforce for adults with cancer older than 65 years and to determine whether there were differences in patients who received care from different providers (eg, nurse practitioners [NPs], physician assistants [PAs], and specialty physicians). DESIGN Observational, cross-sectional study. SETTING Adults within the 2013 Surveillance, Epidemiology, and End Results cancer registries linked to the Medicare claims database. PARTICIPANTS Medicare beneficiaries who received ambulatory care for any solid or hematologic malignancies. MEASUREMENTS International Classification of Diseases, Ninth Revision (ICD-9), diagnosis codes were used to identify Medicare patient claims for malignancies in older adults. Providers for those ambulatory claims were identified using taxonomy codes associated with their National Provider Identifier number. RESULTS A total of 2.5 million malignancy claims were identified for 201, 237 patients, with 15, 227 providers linked to claims. NPs comprised the largest group (31.5%; n = 4,806), followed by hematology/oncology physicians (27.7%; n = 4,222), PAs (24.7%; n = 3767), medical oncologists (10.9%; n = 661), gynecological oncologists (2.6%; n = 403), and hematologists (2.4%; n = 368). Rural cancer patients were more likely to receive care from NPs (odds ratio [OR] = 1.84; 95% confidence interval [CI] = 1.65-2.05) or PAs (OR = 1.57; 95% CI = 1.40-1.77) than from physicians. Patients in the South were more likely to receive care from NPs (OR = 1.36; 95% CI = 1.24-1.49). CONCLUSIONS A large proportion of older adults with cancer receive care from NPs and PAs, particularly those who reside in rural settings and in the southern United States. Workforce strategies need to integrate these provider groups to effectively respond to the rising need for cancer care within the older adult population.